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  • Q&A with Australian Health Practitioners

    What are the procedure options for total hip joint replacement?

    Related Topic
    Orthopaedics
    I am a 74 year old male who will be needing a replacement hip joint. I feel I am not well informed on the various types of procedures available and I am particularly interested in the anterior approach. I understand the anterior approach can result in numbness and/or pain on the thigh ? I would really appreciate any advice or opinions on the positives or negatives of of the anterior and posterior approaches for this operation. I am still reasonably mobile and am not on any prescribed painkillers - just panadol infrequently after walking a distance or gardening. I can cycle fairly long distances without problems
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  • 7

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    Dr Chien-Wen Liew

    Orthopaedic Surgeon

    Adelaide Orthopaedic HIP, KNEE and SHOULDER Surgeon specialising in Sports Injury and Joint Replacement. View Profile

    The current recommendation is that you should use the approach most familiar to your surgeon that you are seeing. I understand your frustration as there are many different options for approach, implant type, bearing type etc. 

    The first thing to determine is if you actually need a hip replacement. If you are cycling and not in much pain, and are able to sleep, then you may not require one. If you have gone down this path already, then a hip replacement is a great option when the time is right. 

    I perform all of my total hip replacements using the Direct Anterior Approach. I choose to use it because it avoids cutting muscles to gain access to the hip. I have found with my patients that the recovery is rapid, pain is minimal, and function is excellent. 

    There are nerve risks in all approaches to the hip. For example, with the posterior approach, the risk is to the sciatic nerve (Supplies the ankle with movement and foot with sensation); with the anterior approach there is risk to a nerve called the Lateral Femoral Cutaneous nerve of the thigh. This nerve supplies sensation only, and does not supply any muscle. The current research shows that damage to this nerve is usually temporary, but more frequent. Whilst the rate of sciatic nerve damage is around the 1-2% mark, the risk of lateral femoral cutaneous nerve damage is around the 20% mark. Personally, I have not found this to be an issue, either functionally, or with pain. 

    Thigh pain is not a feature of many hip replacements, performed in any method. There are some cases where the thigh is painful after very stiff implants are inserted, due to the pain of the stem tip pressing hard against the bone. This can occur in any replacement and is not related to any approach. 

    The important thing is finding a surgeon that you know has good results. A good start is asking around to other patients about their experiences, as they are the best people who can guide you as to actual expectations. As surgeons, we all feel that the approach that we perform is the best one for our patients, in our hands, or we wouldn't be using them. 

    I hope this helps to answer your question

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  • 9

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    Mr Ilan Freedman

    Orthopaedic Surgeon

    Mr Ilan Freedman is a Dual-Fellowship trained Melbourne Orthopaedic Surgeon with specialist experience in Direct Anterior Minimally Invasive Hip Replacement, Bikini Anterior Hip Replacement, Conformis … View Profile

    Hip Replacements can generally be performed through three main ways or "approaches":

    Posterior, Lateral and Anterior.

    Each approach has it's own potential advantages or drawbacks and so surgeons are not in agreement as to which is the "best". As my colleage suggested, the most important consideration is to find a surgeon who has a good reputation and with whom you have good rapport. Excellent and reliable results can be obtained with any of the approaches if the surgeon is experienced and does a good job.

    I personally prefer the Anterior approach as it completely avoids cutting mucle, which is different to the other approaches. Most surgeons in Australia do not use this approach as it can be technically more difficult and they are not familiar with it, but my personal opinion (again, not shared by all surgeons) is that it presents compelling advantages for the surgeon properly trained in the technique.

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  • 5

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    Dr David Agolley

    Orthopaedic Surgeon

    Dr David Agolley is an Australian trained Orthopaedic Surgeon, with specialist expertise in hip and knee surgery. Special interests are robotic and computer assisted hip … View Profile

    Firstly, by the sound of your activity profile, you probably don't need a hip replacement just yet, so if someone if offering you one now, then get a second opinion from another hip surgeon.

    Secondly, there are advantages of an anterior approach including earlier free mobility, less pain relief requirements after surgery and a theoretical more stable hip replacement.

    When you are ready for your hip replacement, as long as you have it done by a surgeon who is confident with either the anterior or posterior approach as you are asking for, you have a good rapport with the surgeon, and they use implants that have reliable data to support its longevity, then you will likely have an excellent outcome either way. Recomendations from your GP or word of mouth from people you trust is usually the best way to find a good surgeon.

    Good luck.

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  • 8

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    Dr Siva Chandrasekaran

    Orthopaedic Surgeon

    A total hip replacement is an operation for improvement in pain and function. From the description it appears that non-operative management is adequately addressing your pain and function and therefore the benefits from a total hip replacment may be minimal.

    With respect to the surgical approach for a hip replacement there are advantages and disadvantages for both anterior and posterior approaches. In my experience the anterior approach does offer earlier return to function but both approaches do have similar function at the six week mark.  I would not offer an anterior approach for patients with prominent skin folds with increase risk of groin moisture for possible wound healing issues.  A would perform a posterior approach if I required a more extensile approach to the femur that may require an osteotomy or trochanteric slide.  In summary the approach is a may of accessing the hip and more importantly it should not compromise component positioning and fixation which is important for longevity of the replacment.

    All the best.

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